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Brain & Heart Cerebral venous thrombosis mimicking brain tumors

1. Introduction therapies, including maximum resection, radiotherapy,
and chemotherapy, play a crucial role in the treatment of
Cerebral venous thrombosis (CVT), a relatively rare type brain gliomas . CVT is best treated with a comprehensive
[18]
of cerebrovascular disease, is defined as thrombosis of therapy, emphasizing the management of pathogenic
the intracranial veins or sinuses. CVT accounts for 0.5% factors, antithrombotic therapy, and symptomatic
of strokes, with a bimodal age distribution: The first peak treatment [2,19] . Biopsy often is the last resort for cases with
in neonates and the second in individuals in their 30 s [1,2] . difficulty in pre-operative diagnosis . Invasive surgery for
[7]
It is a multifactorial disease with several etiologies, and CVT remains controversial. Although heparin, as a first-
thus requires extensive preliminary screening. Moreover, line anticoagulant therapy, can improve the prognosis
CVT can cause vascular and cytotoxic edema, of which the of CVT, aggressive treatment should also be considered
mechanism remains unclear [2,3] . Most patients with CVT for patients who are deteriorating . So far, given the
[1]
have favorable prognoses, with a mortality rate of <10%, equivocal evidence of efficacy for local thrombolysis, it has
which is better than that of arterial stroke [2,4] . However, it is not yet been considered a first-line treatment for CVT .
[2]
difficult to predict the individual prognosis of patients with This retrospective qualitative study aimed to analyze the
CVT . Existing studies have mostly focused on arterial distinctive and clinicopathological features of patients
[1]
cerebral infarction, without much attention to CVT. with CVTMBT. In particular, we performed messenger
Large hemorrhagic cerebral infarction accompanied by ribonucleic acid (mRNA) sequencing on human lesion
prominent vascular edema and brain tissue displacement peripheral tissues from four CVTMBT samples and four
may result in life-threatening complications when patients non-CVTMBT samples from our hospital to identify the
experience deterioration, due to delayed diagnosis and gene expression signatures in this distinctive lesion.
treatment . An epileptic state is considered a cause of
[5]
acute death in CVT . Altered consciousness can occur 2. Materials and methods
[2]
in 15 – 19% patients with extensive venous embolism or
bilateral thalamic involvement . Hence, early and accurate 2.1. Study subjects
[6]
diagnosis and treatment are often associated with better Patients with an initial diagnosis of intracranial
prognosis . occupying lesion and who underwent surgical treatment
[7]
Patients with CVT can be easily misdiagnosed with at our neurosurgical center between November 2016 and
various nervous system diseases due to its rarity, limited October 2021 were reviewed systematically. The inclusion
neuroimaging findings, and varying initial clinical criteria were as follows: Patients (1) initially diagnosed
manifestations, including isolated headache, focal with brain tumor, with their post-operative pathological
neurological dysfunction, and altered consciousness . results revealing CVT; (2) with available pre-operative
[1]
and post-operative neuroimaging examination results,
These manifestations may present separately or in which were evaluated by multiple experienced radiologists
combination with other signs and symptoms . An early and neurosurgeons; and (3) with consecutive medical
[2]
diagnosis of CVT is primarily established by magnetic data and sufficient follow-up information. The exclusion
resonance imaging (MRI) and magnetic resonance criteria included the following: Patients (1) pathologically
venography. Several studies have well-characterized the diagnosed with other space-occupying lesion; (2) with
imaging findings of CVT, which predominantly presents insufficient consecutive neuroimaging information;
with a space-occupying effect [8,9] . However, these studies (3) with incomplete medical data and follow-up
have several limitations and technical flaws [1,5,10,11] . Cerebral information, and (4) with CVT who did not present with
venous infarction, which is observed in approximately 60% brain tumor-like features. Five patients with CVTMBT
of patients with CVT, may present with malignant vasogenic were included as the study subjects, but one of these patients
edema with minor parenchymal hemorrhage and a space- refused to provide biological specimens. The subjects’
occupying mass-like enhancement in primary MRI; thus, baseline characteristics, including demographics, pre-
it is often misdiagnosed as brain tumor [3,5,12] . Fewer than operative neurological dysfunction status, routine blood
10 cases of CVT mimicking brain tumor (CVTMBT) have and coagulation function status, course of disease, seizure
been reported in the previous studies [7,11,12-15] . Moreover, characteristics, detailed surgical records, and other vital
CVT can also manifest as subarachnoid hemorrhage or a records, were collected. Four subjects with CVTMBT had
metastatic tumor [7,16,17] . In cases where establishing a pre- not received previous treatments before surgery and their
operative diagnosis is difficult, biopsy is performed .
[7]
specimens were obtained from the tissues surrounding the
In fact, differentiating CVTMBT from neuroglioma infarcts during surgery at the initial diagnosis. Another
earlier on is necessary because the treatments and four normal brain tissues were obtained at the time of
prognoses for these two diseases are different. Conventional surgery from four non-CVTMBT patients, including

Volume 1 Issue 1 (2023) 2 https://doi.org/10.36922/bh.v1i1.188